With Trump’s surprising win in the US presidential election and the Republicans retaining control of the House and Senate, it looks like ObamaCare’s viability is at serious risk. ObamaCare, officially known as the Affordable Care Act (ACA), has been long maligned by Trump and Republicans and the promise was that it would be repealed on day one of a new Republican presidency. But with over 20 million Americans on ObamaCare, repealing it without providing a replacement would be a politically unwise move, despite the ongoing complaints of increasing premiums and fines. Various other provisions under ACA laws like including covering those with pre-existing health conditions, free birth control and extended coverage for young adults under family health insurance plans, are very popular and not as easy to unwind.
Here is what various pundits and experts are saying about the prospect of a Obamacare Repeal and/or Replace (ORR) and likely approaches/impacts.
Emma Court at MarketWatch says this on the Obamacare Repeal and Replace (ORR), “….Repealing Obamacare may not be that easy to pull off given changes already made in the health care delivery system.There are also legislative realities to contend with. Republican majorities in the House of Representatives and Senate aren’t enough to repeal the ACA on their own, but other legislative processes would allow major provisions of the law to be gutted. Far more likely than repeal is that the law will be retained but massively changed, some experts say. Either scenario entails massive disruption for an industry that isn’t exactly limber in the face of change……With health care making up 20% of the U.S. gross domestic product, big changes could have big consequences for workers and companies alike, many experts note. Repealing (or even watering-down) Obamacare could negatively impact health care spending and, in turn, the demand for health care labor hurting health care staffing provider…”
Megan McArdle at Bloomberg says, “…Repeal will involve getting rid of the unpopular bits. But it will also involve getting rid of the popular bits, which include the: guaranteed issue/coverage despite preexisting conditions and community rating” (insurers can’t agree to sell a policy to some undesirable customer for a million dollars a year; the company has to sell to everyone in a given age group at the same price). So I suspect that “Repeal Obamacare” will meet the same fate as Social Security reform that Bush tried to push. Legislators were gung-ho and even though his [Bush, Republicans] party had control of both the House and the Senate, Bush eventually had to admit he couldn’t get it done. His own party would not back him in the face of voter resistance.
What might Republicans do instead? The most obvious answer is: Wait for it to die a natural death. While Trump will not be pushing particularly hard for repeal, he will probably not be pushing to save Obamacare either. There will be no special deals for insurers who stick with the exchanges. Obamacare’s market structure is so deeply flawed that even benign neglect will probably prove fatal in fairly short order. The problem is that for this to become possible, things have to get much worse before they get better. Moreover, the disaster of Obama’s experiment will have tainted health-care reform. No politician will want to touch it for a good long while. Meaning that we will, at best, manage to return to the situation we had before Obamacare — a situation that no one was satisfied with. That’s nothing to celebrate on either side of the aisle…”
Alison Kodjak at NPR says, “Repeal of the law is absolutely going to come up, and the only potential defense against that would be a Democratic filibuster — if Republicans even allow a filibuster. But even if Trump can’t repeal the Affordable Care Act in its entirety, there’s a lot he can do through rule-making and smaller legislative changes to weaken the law and mold it more to his liking. This includes promoting tax-free health savings accounts that might help individuals save money to pay for health care costs and allowing people to deduct the cost of their premiums on their personal income tax returns. Trump has said he also wants to allow insurers to sell policies across state lines to boost competition. An analysis of Trump’s plan by The Commonwealth Fund estimates it would increase the number of people who lack health insurance by as many as 25 million, and increase the federal budget by as much as $41 billion. Alternatively, Trump could embrace the health care plan promoted by House Speaker Paul Ryan, which starts with repealing the Affordable Care Act. It includes many of the same principles as Trump’s plan, but has more details. Even if Trump fails to repeal the law….he could easily destroy it from within by refusing to fund it through the budget process….”
Margot Sanger-Katz of the NY times says, “We have a pretty good idea of what such legislation would look like. Last year, the Senate passed a reconciliation bill that undid large portions of the health bill. The House passed it. And President Obama vetoed it. That bill, the “Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015,” would eliminate Obamacare programs to provide Medicaid coverage for Americans near or below the poverty line. It would eliminate subsidies to help middle-income Americans buy their own insurance on new marketplaces. It would eliminate tax penalties for the uninsured, meant to urge everyone to obtain health insurance. And it would eliminate a number of taxes created by the law to help fund those programs….If we believe Donald J. Trump, who has vowed repeatedly to repeal Obamacare, he would seem likely to sign such a bill. Republicans often talk about “repealing and replacing” the Affordable Care Act. But without a Senate supermajority, the replacement part may be politically impossible. Making the kind of legislative changes to stabilize disrupted markets — or to enact the kind of broader health care reform Mr. Trump has spoken about on the campaign trail — will require 60 votes in the Senate. Without those votes, the new Republican government will have the power to repeal substantial parts of the health law, but it may not be able to replace them.”
Leave your comments and thoughts below on where you think debate on this topic will go and your views on it.